eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Mumps

Cem S Demirci, MD, Fellow in Endocrinology, Children's Hospital of Pittsburgh
Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center

Updated: Nov 20, 2009

Introduction

Background

Mumps is a single-stranded RNA virus and a member of the family Paramyxoviridae, genus Paramyxovirus. It has 2 major surface glycoproteins: the hemagglutinin-neuraminidase and the fusion protein. Mumps virus is sensitive to heat and ultraviolet light.

Mumps vaccine was licensed in the United States in December 1967, and the Advisory Committee on Immunization Practices (ACIP) recommended that its use be considered for children approaching puberty, for adolescents, and for adults. At that time, the public health community considered mumps control a low priority, and the ACIP stated that mumps immunization should not compromise the effectiveness of established public health programs. However, in 1972, the ACIP recommendations were strengthened to indicate that mumps vaccination was particularly important for the initially targeted age groups; in 1977, the ACIP recommended the routine vaccination of all children aged 12 months or older.

The use of mumps vaccine in young children was facilitated by the introduction (in 1977) and extensive use of the measles-mumps-rubella (MMR) vaccine. In 1980, stronger recommendations called for the vaccination of susceptible children, adolescents, and adults, unless such vaccination was contraindicated. Following these increasingly comprehensive recommendations and the enactment of state laws requiring mumps vaccination for school entry and attendance, the reported incidence of mumps steadily declined. However, during 1986 and 1987, large outbreaks occurred among underimmunized cohorts of persons born during 1967-1977, resulting in a shift in peak incidence from persons aged 5-9 years to persons aged 10-19 years.¹ In 1989, the ACIP recommended that a second dose of measles-containing vaccine be administered to children aged 4-6 years (at time of entry to kindergarten or first grade) and designated MMR as the vaccine of choice.^1,2

The incidence of mumps during 1988-1998 decreased among all age groups. The greatest decrease occurred among persons aged 10-19 years, which was the same age group in which the greatest increases had occurred during 1986 and 1987, when a resurgence of outbreaks occurred among susceptible adolescents and young adults. Subsequent outbreaks have occurred among highly vaccinated populations. During 1989-1990, a large outbreak occurred among students in a primary and a secondary school; most of the students in these schools had been vaccinated, suggesting that vaccination failure, in addition to failure to vaccinate, might have contributed to the outbreak. In 1991, another outbreak occurred in a secondary school where most of the students had been vaccinated; this outbreak was also mostly attributed to primary vaccination failure.

The shift in higher risk for mumps to these other age groups (ie, from younger children of school ages to older children, adolescents, and young adults), which occurred after the routine use of the mumps vaccine was initiated, has persisted despite minimal fluctuations in disease incidence that occurred in recent years among the various age groups.

Pathophysiology

Mumps virus produces a generalized infection. After entry into the oropharynx, viral replication occurs, causing subsequent viremia and involving glands or nervous tissue.

Child with mumps.

Frequency

United States

After the licensure of the mumps vaccine in the United States in December 1967 and the subsequent introduction of state immunization laws in an increasing number of states, reported incidence of mumps substantially decreased. The 666 cases of mumps reported in 1998 reflect a 99% decrease from the 152,209 cases reported for 1968. Although incidence decreased in all age groups, the largest decreases (>50% reduction in incidence rate per 100,000 population) occurred in persons aged 10 years or older. Overall, the incidence of mumps was lowest in states with comprehensive school immunization laws requiring mumps vaccination and was highest in states without such requirements.

The prevalence of mumps is at record low levels because of the recommendation of 2 doses of MMR vaccine and its high coverage rate in the United States. During the 1990s, mumps cases substantially declined, from 5,292 reported cases in 1990 to 266 reported cases in 2001, meeting the Healthy People 2000 objective of less than 500 cases per year. In 2003, the Centers for Disease Control and Prevention (CDC) reported a total of 231 cases.³

However, on July 26, 2005, an epidemic occurred in Sullivan County, New York at a summer camp.⁴ An investigation conducted by the New York State Department of Health (NYSDOH) identified 31 cases of mumps, likely introduced by a camp counselor who had traveled from the United Kingdom and had not been vaccinated for mumps. Even in a population with 96% vaccination coverage, as was the case with participants in the summer camp, a mumps outbreak can result from exposure to virus imported from a country with an ongoing mumps epidemic. The likelihood of disease in US residents caused by imported virus from areas with mumps epidemics remains high.

International

Because the virus is present throughout the world, risk of exposure to mumps outside the United States may be high. Mumps remains endemic in many countries throughout the world, and mumps vaccine is used in only 57% of countries that belong to the World Health Organization, predominantly in countries with more developed economies.⁵ In England and Wales, an epidemic of mumps began in 2005, with 56,390 notified cases reported.⁶

Mortality/Morbidity

Death due to mumps is rare; more than half of the fatalities occur in persons older than 19 years.

Mumps encephalitis occurrence ranges as high as 5 cases per 1000 reported mumps cases, and males are affected 3-5 times more frequently than females. Permanent sequelae are rare, but the reported encephalitis case-fatality rate has averaged 1.4%.

Approximately 10% of all infected patients develop a mild form of meningitis, which could be confused with bacterial meningitis. Encephalitis, transient myelitis, or polyneuritis is rare. Unilateral hearing loss is associated with mumps infection but is also rare.

Orchitis occurs in 10-20% of patients; subsequent sterility is rare. Oophoritis is quite rare and is usually a benign inflammation of the ovaries. Other rare complications include myocarditis, nephritis, arthritis, thyroiditis, pancreatitis, thrombocytopenia purpura, mastitis, and pneumonia. These usually resolve within 2-3 weeks without sequelae.

Race

During 1990-1998, race and ethnicity were reported for approximately two thirds of cases in each of 28 states and the District of Columbia. Mumps incidence decreased for people of all races during this 4-year period. For each year, incidence was highest among black persons, ranging from 1.2-8.2 times the incidence of any other racial group. In people of every age group, incidence rates for black persons exceeded rates for people of other racial groups; this relationship was most notable for persons aged 5-19 years.

Although incidence rates for Hispanics exceeded the rates for non-Hispanics in every age group, differences in rates were minimal for children younger than 5 years and for persons aged 20 years or older. The greatest difference in incidence rates between Hispanics and non-Hispanics was in persons aged 5-19 years.

Sex

No sexual predilection is observed.

Age

As in the prevaccine era, most reported mumps cases still occur in school-aged children (aged 5-14 y). Almost 60% of reported cases occurred in this population from 1985-1987, compared with an average of 75% of reported cases from 1967-1971, the first 5-year period postlicensure. However, for the first time since mumps became a reportable disease, the reported peak incidence rate shifted from children aged 5-9 years to older age groups for 2 consecutive years (ie, 1986, 1987).

Persons aged 15 years or older accounted for more than one third of the reported total from 1985-1987, whereas during the period 1967-1971, an average of only 8% of reported cases occurred among this population. Although reported mumps incidence increased in all age groups from 1985-1987, the most dramatic increases were among adolescents aged 10-14 years (almost a 7-fold increase) and young adults aged 15-19 years (more than an 8-fold increase).

Increased occurrence of mumps in susceptible adolescents and young adults has been demonstrated in several recent outbreaks in high schools, on college campuses, and in occupational settings.⁷ Nonetheless, despite this age shift in reported mumps, the overall reported risk of disease in persons aged 10-14 and those aged 15 years or older is still lower than that in the prevaccine and early postvaccine era.

Clinical

History

The incubation period is 14-21 days, and mumps is communicable from 6 days before to 9 days after facial swelling is apparent. However, 30% of infections are subclinical.

• Symptoms in the history mostly consist of fever, headache, and malaise. Within 24 hours, patients report an ear pain localized near the lobe of the ear and aggravated by a chewing movement of the jaw. The fever usually subsides after a variable period of as long as 1 week, well before the salivary gland edema disappears.
• Older children may describe a sensation of swelling at the angle of the jaw in the early stage, especially with a sour taste.

Physical

After the prodromal period, one or both parotid glands begin to enlarge; 70-80% of cases are bilateral. Edema over the parotid gland typically occurs with nondiscrete borders, pain with pressure, and obscured angle of the mandible. A recent study investigated the difficulty in definitive mumps diagnosis, noting that only 14% of 2082 cases during an outbreak were laboratory confirmed.⁸ The conclusion was that the clinical acumen for mumps diagnosis based solely on clinical presentation is low.

• Parotitis: The classic illness of mumps consists of swelling of the parotid gland (ie, parotitis, parotiditis). Systemic symptoms include low-grade fever, headache, malaise, anorexia, and abdominal pain. Acid-containing foods may aggravate discomfort of the parotid gland. Ordinarily, the parotid gland is not palpable, but in patients with mumps, it rapidly progresses to maximum swelling over several days. Unilateral swelling usually occurs first, followed by bilateral parotid involvement. Occasionally, simultaneous involvement of both parotid glands occurs. Unilateral parotid disease occurs in fewer than 25% of patients. Fever subsides within 1 week and disappears before swelling of the parotid gland resolves, which may require as long as 10 days. Other salivary glands may be involved, including both submaxillary glands and sublingual glands, and orifices of the ducts may be erythematous and edematous.
• Orchitis: Approximately one third of postpubertal male patients develop unilateral orchitis. It usually follows parotitis but may precede parotitis or occur in the absence of parotitis. Usually, it appears in the first week of parotitis, but it can occur in the second or third week. Bilateral orchitis occurs much less frequently, and although gonadal atrophy may follow orchitis, sterility is rare even with bilateral involvement. Prepubertal boys may develop orchitis, but it is uncommon in those younger than 10 years. Orchitis is accompanied by high fever, severe pain, and swelling. Nausea, vomiting, and abdominal pain are not uncommon. Fever and gonadal swelling usually resolve in 1 week, but tenderness may persist.
• Meningoencephalitis
  • CNS involvement with mumps is not uncommon, and it occurs more often as meningitis rather than true encephalitis. It may precede parotitis or appear in the absence of parotitis but usually occurs in the first week after parotitis. Headache, fever, nausea, vomiting, and meningismus are common. Marked changes in sensorium and convulsions are not usual. Pleocytosis of the CSF occurs in a high percentage of persons without clinical evidence of central nervous system involvement.
  • In clinically diagnosed meningoencephalitis, a CSF mononuclear pleocytosis occurs, as does normal glucose, although hypoglycorrhachia has been reported. The mumps virus may be isolated from CSF early in the illness. Mumps meningoencephalitis carries a good prognosis and is usually associated with an uneventful recovery. Other clinical manifestations of mumps include pancreatitis accompanied by severe abdominal pain, chills, fever, and persistent vomiting. Thyroiditis, oophoritis, and mastitis occasionally occur.
• Deafness: Neuritis of the auditory nerve may result in deafness. Sudden onset of tinnitus, ataxia, and vomiting is followed by permanent deafness. Other neurologic complications include facial nerve neuritis and myelitis.
• Other complications: Less common complications include arthritis, myocarditis, and hematologic complications.

Causes

• Lack of immunization, international travel, and immune deficiencies can make a child more prone to infection by Paramyxovirus mumps virus.

Differential Diagnoses

Human Immunodeficiency Virus Infection

Other Problems to Be Considered

Coxsackievirus parotitis
Influenza virus parotitis
Parainfluenza virus parotitis
Suppurative parotitis commonly caused by Staphylococcus aureus or other bacteria
Adenitis
Recurrent parotitis
Calculus of Stensen duct
Tumors of the parotid gland
Mikulicz syndrome
Meningoencephalitis

Workup

Laboratory Studies

• Diagnosis of mumps is clinical, and laboratory tests are unnecessary. The virus can be isolated from saliva or mouth washings in primary monkey kidney tissue culture.
• Diagnosis can also be made by significant rise between acute and convalescent phase titers in serum mumps immunoglobulin G (IgG) antibody level using any standard serologic assay or positive serologic test for mumps immunoglobulin M (IgM) antibody. Interpretation of titer rise may have limitations because of mumps cross-reaction with parainfluenza viruses.
• Serum amylase is elevated in mumps parotitis and pancreatitis. Serum lipase is elevated in pancreatitis.
• CBC count reveals a normal or elevated WBC count with lymphocyte predominance.
• Viruria is common even in uncomplicated mumps.

Imaging Studies

• Imaging may only be needed for complicated cases that involve certain organ systems.

Other Tests

• Complicated cases may need further testing, if determining organ system involvement is necessary.

Procedures

• Lumbar puncture may be needed to obtain cell profile and culture information if meningoencephalitis is the prominent presentation.

Treatment

Medical Care

• Conservative therapy is indicated in patients with mumps.
• Generous offering of fluids is essential because adequate hydration and alimentation of patients is important.
• Foods and liquids that contain acid may cause swallowing difficulty as well as gastric irritation.
• Prescribe analgesics for severe headaches or discomfort due to parotitis. In orchitis, stronger analgesics may be needed.
• No antiviral agent is indicated for mumps, which is a self-limited disease.

Consultations

• Consultation may be considered in complicated cases with multiple organ system involvement.

Diet

• A light diet with generous fluid intake is recommended.
• Avoiding acid-containing foods (eg, tomato, vinegar-containing food additives) and liquids (eg, orange juice) are beneficial to reduce pain.

Activity

• Bed rest is recommended for a faster recovery and is needed for patients with complicated cases.

Medication

Analgesics

These agents may be prescribed for severe headaches or discomfort due to parotitis. In orchitis, stronger analgesics may be needed.

Ibuprofen (Advil, Motrin)

DOC for patients with mild-to-moderate pain and fever. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Dosing

Adult

200-400 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d

Pediatric

10 mg/kg/dose q8h prn for relief of pain/fever; not to exceed 2.4 g/d

Interactions

Coadministration with aspirin increases risk of inducing serious NSAID-related side effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy

Acetaminophen (Tylenol, Tempra)

DOC for pain in patients with documented hypersensitivity to NSAIDs, with upper GI disease, or who are taking PO anticoagulants. Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.

Dosing

Adult

325-650 mg PO q4-6h or 1000 mg tid/qid; not to exceed 4 g/d

Pediatric

15 mg/kg/dose q4-6h prn for relief of pain/fever; not to exceed 2.6 g/d

Interactions

Rifampin can reduce analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity

Contraindications

Documented hypersensitivity; known G-6-P deficiency

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Hepatotoxicity possible in people with long-term alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; APAP is contained in many OTC products, and combined use with these products may result in cumulative APAP doses exceeding recommended maximum dose

Vaccines (measles, mumps, rubella)

Prevention of mumps through immunization cannot be overemphasized. All children younger than 7 years should receive the mumps vaccine. In the United States, mumps vaccine is recommended and is usually combined with MMR.

Measles, mumps, and rubella vaccine (M-M-R)

Live virus vaccine. Combined MMR vaccine is recommended for the prevention of mumps, measles, and rubella. For children, the typical recommended 2 dose schedule is administered at age 12-15 mo for the 1st dose and the second dose at 4-6 y of age.

Dosing

Adult

0.5 mL SC in outer aspect of upper arm
Adults in 1957 or after should receive one dose of MMR unless they have a medical contraindication, history of mumps, laboratory evidence of immunity
A second dose is recommended for adults in an age group affected during a mumps outbreak, students in postsecondary educational institutions, work in a health care facility, or for international travel

Pediatric

0.5 mL SC in outer aspect of upper arm
Administer 1st dose between age 12-15 mo; administer the 2nd dose between age 4-6 y

Interactions

Patients receiving immunosuppressants, including corticosteroids or radiation therapy, may remain susceptible despite immunization because of poor immune response

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Fever, rash, lymphadenopathy, parotitis, allergic reactions, thrombocytopenia, arthralgia, arthritis, and persistent or recurrent arthropathy; interference with tuberculin skin tests; contraception in females is advised for 3 mo following immunization; not indicated for immunocompromised patients

Follow-up

Deterrence/Prevention

• Droplet precautions are recommended until 9 days after the onset of parotid swelling in patients with mumps. Children should be excluded for 9 days from the onset of parotid gland swelling from going to school and child care centers. If outbreaks occur, all children should be vaccinated.
• Susceptible children, adolescents, and adults should be vaccinated against mumps, unless vaccination is contraindicated. Mumps vaccine is of particular value for children approaching puberty and for adolescents and adults who have not had mumps. MMR vaccine is the vaccine of choice for routine administration and should be used in all situations where recipients are also likely to be susceptible to measles, rubella, or both. The favorable benefit-to-cost ratio for routine mumps immunization is more marked when vaccine is administered as MMR. Persons should be considered susceptible to mumps unless they have documentation of (1) physician-diagnosed mumps, (2) adequate immunization with live mumps virus vaccine on or after their first birthday, or (3) laboratory evidence of immunity.
• Because live mumps vaccine was not used routinely before 1977 and because the peak age-specific incidence was in children aged 5-9 years before the vaccine was introduced, most persons born before 1957 are likely to have been naturally infected from 1957-1977. Therefore, they may generally be considered to be immune, even if they may not have had clinically recognizable mumps disease. However, this cutoff date for susceptibility is arbitrary. Although outbreak control efforts should be focused on persons born after 1956, these recommendations do not preclude vaccination of possibly susceptible persons born before 1957 who may be exposed in outbreak settings.
• Persons who are unsure of their mumps disease history, mumps vaccination history, or both should be vaccinated. No evidence indicates that persons who have previously either received mumps vaccine or had mumps are at any increased risk of local or systemic reactions from receiving live mumps vaccine. Testing for susceptibility before vaccination, especially among adolescents and young adults, is not necessary. In addition to the expense, some tests (eg, mumps skin test, complement-fixation antibody test) may be unreliable, and tests with established reliability (eg, neutralization test, enzyme immunoassay, radial hemolysis antibody test) are not readily available.
• A single dose of vaccine in the volume specified by the manufacturer should be administered subcutaneously. Although not routinely recommended, intramuscular vaccination is effective and safe.
• Administration of the live mumps virus vaccine is recommended at any age on or after the first birthday for all susceptible persons, unless a contraindication is present. Under routine circumstances, mumps vaccine should be administered in combination with measles and rubella vaccines as MMR, following the currently recommended schedule for administration of measles vaccine. It should not be administered to infants younger than 12 months because persisting maternal antibody might interfere with seroconversion. To ensure immunity, all persons vaccinated before the first birthday should be revaccinated on or after the first birthday.
• When administered after exposure to mumps, live mumps virus vaccine may not provide protection. However, if the exposure did not result in infection, vaccine should induce protection against infection from subsequent exposures. No evidence indicates that the risk of vaccine-associated adverse events increases if vaccine is administered to persons incubating disease.
• Immunoglobulin has not been demonstrated to be of established value in postexposure prophylaxis and is not recommended. Mumps immunoglobulin has not been shown to be effective and is no longer available or licensed for use in the United States.

Complications

• Hearing loss
• Meningitis or encephalitis
• Orchitis
• Oophoritis
• Pancreatitis
• Transient myelitis
• Polyneuritis
• Myocarditis
• Nephritis
• Arthritis
• Thyroiditis
• Thrombocytopenia purpura
• Mastitis
• Pneumonia
• Sensorineural deafness

Prognosis

• Overall prognosis in uncomplicated mumps is excellent.
• Prognosis of patients with meningoencephalitis is generally favorable; however, neurologic damage and death can occur. Reported rates of mumps encephalitis range as high as 5 cases per 1000 reported mumps cases. Permanent sequelae are rare, but the reported encephalitis case-fatality rate has averaged 1.4%.
• Sensorineural deafness is one of the most serious of the rare complications involving the CNS. It occurs with an estimated frequency of 0.5-5 cases per 100,000 reported mumps cases. Minor degrees of hearing loss or impairment are likely to occur with higher incidence and are probably reversible. Deafness after mumps is rare, mostly unilateral (20% bilateral), and often permanent.
• Orchitis (usually unilateral) has been reported as a complication in 20-30% of clinical mumps cases in postpubertal males. Some testicular atrophy occurs in about 35% of cases of mumps orchitis, but sterility rarely occurs.
• Symptomatic involvement of other organs has been observed less frequently. Limited experimental, clinical, and epidemiologic data suggest permanent pancreatic damage may result from injury caused by direct viral invasion. Further research is needed to determine whether mumps infection contributes to the pathogenesis of diabetes mellitus.
• Mumps infection in pregnant women seems to increase the risk of embryonic and fetal death and spontaneous abortions, especially during the first trimester of pregnancy (reported to be as high as 27%). No association was found between mumps and congenital anomalies, and the studies relating maternal mumps infection to endocardial fibroelastosis in the fetus are inconclusive. Mumps during pregnancy was rare even before immunization and is even rarer with the widespread use of mumps immunization in childhood.

Patient Education

• The principal strategy to prevent mumps is to achieve and maintain high immunization levels, primarily in infants and young children. Universal immunization as a part of good health care should be routinely carried out in physicians' offices and public health clinics. Programs aimed at vaccinating children with MMR should be established and maintained in all communities. In addition, all other persons thought to be susceptible should be vaccinated unless otherwise contraindicated. This is especially important for adolescents and young adults in light of the recently observed increase in risk of disease in these populations.
• Advise parents and educators to exclude the infected child from large-population facilities until 9 days after the swelling begins or until the swelling subsides.
• Advise all children and adults to follow good handwashing practices.
• For excellent patient education resources, visit eMedicine's Common Childhood Illnesses Center, Children's Health Center, and Bacterial and Viral Infections Center. Also, see eMedicine's patient education articles Mumps and Immunization Schedule, Children.

Miscellaneous

Medicolegal Pitfalls

• Failure to advise isolation for the duration of the contamination period
• Failure to check for complicated cases involving certain organ systems
• Failure to check for pregnancy in postpubertal women, including asking if they are or may be pregnant, excluding those who say they are, and explaining the theoretical risk to those who plan to receive the vaccine

Special Concerns

• Mumps in a childcare facility: If a case of mumps occurs in a childcare facility, notify the local health department. Notify parents. Exclude the infected child from the facility until 9 days after the swelling begins or until the swelling subsides. Make sure all children and adults follow good handwashing practices. In large facilities, follow appropriate group separation practices. Review the immunization records of all children in the facility to assure they have received their first mumps vaccination. Those not adequately vaccinated should be referred to their physicians. Closely observe all children for symptoms and refer anyone developing symptoms to his or her physician.
• Adverse effects of vaccine use: In field trials before licensure, illnesses did not occur more often in vaccinees than in unvaccinated controls. Reports of illnesses following mumps vaccination have mainly involved episodes of parotitis and low-grade fever. Allergic reactions, including rash, pruritus, and purpura, have been temporally associated with mumps vaccination but are uncommon, are usually mild, and are of brief duration. The reported occurrence of encephalitis within 30 days of receipt of a mumps-containing vaccine (0.4 cases per million doses) is not greater than the observed background incidence rate of CNS dysfunction in the healthy population. Other manifestations of CNS involvement, such as febrile seizures and deafness, have also been infrequently reported.⁹ Complete recovery is usual. Reports of nervous system illness following mumps vaccination do not necessarily denote an etiologic relationship between the illness and the vaccine.
• Contraindications to vaccine use in pregnancy: Although mumps vaccine virus has been shown to infect the placenta and fetus, no evidence indicates that it causes congenital malformations in humans. However, because of the theoretical risk of fetal damage, avoiding administration of live virus vaccine to pregnant women is prudent. Vaccinated women should avoid pregnancy for 3 months after vaccination. Routine precautions for vaccinating postpubertal women include asking if they are or may be pregnant, excluding those who say they are, and explaining the theoretical risk to those who plan to receive the vaccine. Vaccination during pregnancy should not be considered an indication for termination of pregnancy. However, the final decision about interruption of pregnancy must rest with the individual patient and her physician.
• Severe febrile illness: Vaccine administration should not be postponed because of minor or intercurrent febrile illnesses, such as mild upper respiratory infections. However, vaccination of persons with severe febrile illnesses should generally be deferred until they have recovered.
• Allergies: Because live mumps vaccine is produced in chick embryo cell culture, persons with a history of anaphylactic reactions (ie, hives, swelling of the mouth and throat, difficulty breathing, hypotension, shock) after egg ingestion should only be vaccinated with caution using published protocols. Children with known allergy should not leave the vaccination site for 20 minutes. Evidence indicates that persons are not at increased risk if they have egg allergies that are not anaphylactic in nature. Such persons may be vaccinated in the usual manner. No evidence indicates that persons with allergies to chickens or feathers are at increased risk of reaction to the vaccine. Because mumps vaccine contains trace amounts of neomycin (25 mcg), persons who have experienced anaphylactic reactions to topically or systemically administered neomycin should not receive mumps vaccine.
• Recent immunoglobulin injection: Passively acquired antibody can interfere with the response to live attenuated-virus vaccines. Therefore, mumps vaccine should be administered at least 2 weeks before the administration of immunoglobulin or deferred until approximately 3 months after the administration of immunoglobulin.
• Exceptions: An exception to these general recommendations is in children infected with human immunodeficiency virus (HIV); all asymptomatic HIV-infected children should receive MMR vaccination at 15 months of age. Patients with leukemia in remission whose chemotherapy has been terminated for at least 3 months may also receive live mumps virus vaccine.

Multimedia

Media file 1: Child with mumps.

References

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Keywords

mumps, parotitis, epidemic parotiditis, measles-mumps-rubella vaccine, MMR vaccine, mumps virus, mumps encephalitis, meningitis, transient myelitis, polyneuritis, oophoritis, myocarditis, nephritis, arthritis, thyroiditis, pancreatitis, thrombocytopenia purpura, mastitis, pneumonia, parotitis, orchitis, meningoencephalitis

Contributor Information and Disclosures

Author

Cem S Demirci, MD, Fellow in Endocrinology, Children's Hospital of Pittsburgh
Disclosure: Nothing to disclose.

Coauthor(s)

Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center
Walid Abuhammour, MD, FAAP is a member of the following medical societies: American Medical Association and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Medical Editor

Gary J Noel, MD, Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University
Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

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